Category: Public Health

A federal judge in D.C. ruled Thursday that the Trump administration’s cuts to the Teen Pregnancy Prevention Program were unlawful.

Last summer, the administration notified 81 organizations that their five-year grants through the program would end in 2018, rather than in 2020, prompting multiple lawsuits.

Judge Ketanji Brown Jackson ruled in one of those cases Thursday, ordering the Department of Health and Human Services (HHS) to accept and process applications of four grantees as if they had not been terminated.

“We are disappointed with today’s ruling. As numerous studies have shown, the Teen Pregnancy Prevention Program is not working. Continuing the program in its current state does a disservice to the youth it serves and to the taxpayers who fund it. Communities deserve better, and we are considering our next steps,” said HHS spokesperson Caitlin Oakley in a statement.

The Public Citizen, a consumer rights group in D.C., represented Policy and Research LLC, Project Vida Health Center, Sexual Health Initiatives for Teens and the South Carolina Campaign to Prevent Teen Pregnancy — four of 81 grantees who had their funds cut short by the administration last year.

Several other lawsuits are still playing out in court.

“The court’s decision today is a rebuke of the Trump administration’s effort to kill a program that is working effectively to lower teen pregnancy rates,” said Sean Sherman, an attorney at the Public Citizen Litigation Group. “Because of the court’s ruling, the four grantees will be able to continue to serve their local communities and to conduct important research. The court’s decision confirms that HHS must administer the Teen Pregnancy Prevention Program in accordance with the agency’s own regulations and the requirement of reasoned decision-making.”

The administration abruptly cut the grants off last year, arguing that the programs were ineffective at curbing teenage pregnancy.

The program, created in 2010 under former President Obama, funds organizations working to reduce and prevent teen pregnancy, with a focus on reaching populations with the greatest need.

But it has long been criticized by conservatives for its focus on comprehensive sex education, which can include teaching about safe sex and abstinence.

The Trump administration has quietly reshaped enforcement of air pollution standards in recent months through a series of regulatory memos.

The memos are fulfilling the top wishes of industry, which has long called for changes to how the Environmental Protection Agency (EPA) oversees the nation’s factories, plants and other facilities. The EPA is now allowing certain facilities to be subject to less-stringent regulations and is letting companies use friendlier math in calculating their expected emissions.

Environmentalists and public health advocates say the memos could greatly increase levels of air pollutants like mercury, benzene and nitrogen oxides. They accuse the EPA of avoiding the transparency and public input requirements that regulatory changes usually go through.

“All of these, individually and taken together, will result in more air pollution and less enforcement of the Clean Air Act,” said Paul Billings, senior vice president for advocacy at the American Lung Association.

“These were radical departures of current law when they were proposed a decade ago and they’re just as radical today,” he said, referring to the Bush-era efforts, some of which were unsuccessful, to make changes to EPA air programs.

But for the EPA and its supporters, the memos simply bring the agency back to what the relevant laws and regulations are meant to be.

“They address specific concerns that people have had for years, and just make it much simpler for people to comply — especially for existing [facilities] — to make sure they can maintain their plants and replace worn-out components and those types of things, without the threat of enforcement litigation,” said Jeff Holmstead, a former head of the EPA’s air pollution office under the George W. Bush administration who now represents regulated companies at the law and lobbying firm Bracewell.

Bill Wehrum, head of the air office under EPA chief Scott Pruitt, wrote two of the three EPA memos. He recused himself from the third memo, which Pruitt wrote.

The first memo, issued in December, states that the EPA will no longer “second guess” companies’ calculations of their expected pollution output after certain big projects under what is known as New Source Review. Under that program, the EPA reviews the changes made to a facility to decide whether they need to go through the same process as if the facility were newly built.

The December memo effectively means the EPA will usually not take action against a company for its calculations if they turn out to be wrong.

The second memo, issued in January, repeals a Clinton-era policy known as “once in, always in.” Under the previous policy, facilities could never be considered “minor” sources of hazardous pollution if they were already considered “major” sources, and subject to much stricter rules.

Now, facilities can be regulated as “minor” if their emissions drop enough.

The third memo allows companies to use a procedure known as “project netting” when applying for permits for major projects under the New Source Review program. That means companies can use a more industry-friendly emissions calculation when they argue that a particular project would reduce emissions.

President Trump added to the memos last week, signing one himself that formally asks the EPA to use more industry-friendly practices in enforcing the National Ambient Air Quality Standards program, a key Clean Air Act program for air quality nationwide.

John Walke, director for clean air at the Natural Resources Defense Council, said the EPA is working to implement the policies the Bush administration failed to finish.

“I think Mr. Wehrum has decided this is likely a one-term administration and he’s going to devote his full resources to rolling back clean air, climate and public health protections in the time available to him,” Walke said.

“The most expedient and hasty way to accomplish those rollbacks is through the regular guidance documents that we have seen so far from EPA,” he said. “Rulemakings take time, they require public notice and input and hearings, and Mr. Wehrum and Mr. Pruitt plainly have no patience for those tedious fodders.”

Walke said that, taken together, the memos could allow polluting facilities to greatly increase their emissions.

The EPA didn’t respond to requests for comment.

The focus among the memos for environmental and health advocates is the one repealing the “once in, always in” policy, and letting “major” pollution sources reduce their emissions and be regulated as “minor” ones.

A coalition of environmental groups sued the EPA to stop the policy change, arguing that it should have gone through the full regulatory process, including analysis of its environmental impact and an opportunity for public comment. Democratic states joined in with their own lawsuit.

“Instead of prioritizing the health of hard-working Americans, EPA Administrator Scott Pruitt wants to let major polluters off the hook. That is unconscionable, and it is illegal,” said California Attorney General Xavier Becerra (D).

“If the ‘Once In, Always In’ policy is rescinded, children in California and around the country — particularly those who must live near the polluting plant or factory — may grow up in an environment with tons of additional hazardous pollutants in the air they breathe. California will not allow that to happen,” Becerra said.

Two environmental groups opposed to the EPA’s move have put out recent analyses of the change, focused on specific areas of the country.

The Environmental Integrity Project looked at 12 industrial plants in the Midwest and concluded they could increase their pollution to 540,000 pounds annually, a fourfold growth.

The Environmental Defense Fund looked at the Houston area, and said that 18 facilities there could increase their emissions to 900,000 pounds a year, two and a half times current levels.

Holmstead said opponents of the Trump administration’s policy are unlikely to prevail. The Supreme Court ruled in the 2015 Perez v. Mortgage Bankers Association case that federal agencies can repeal policy memos with other policy memos and don’t have to go through the full regulatory process to do so.

“I think the environmental groups are going to have a real uphill battle trying to get through court that this is somehow improper,” he said. “That really does fly in the face of the Perez decision.”

As for the increase in emissions, Holmstead said environmentalists are wrong. In many cases, the new policies will allow facilities to carry out projects that reduce emissions, or simply operate under a lower paperwork burden.

“They have yet to come up with any real-world examples of how that might happen,” Holmstead said of the scenarios in which pollution might increase. “These reforms are not going to lead to pollution increases.

“I don’t think that there will be a meaningful impact one way or another.”

The Trump administration is seeking to completely revamp the country’s social safety net, targeting recipients of Medicaid, food stamps and housing assistance.

Trump is doing so through a sweeping executive order that was quietly issued earlier this week – and that largely flew under the radar.

It calls on the Departments of Health and Human Services, Housing and Urban Development, Agriculture and other agencies across the federal government to craft new rules requiring that beneficiaries of a host of programs work or lose their benefits.

Trump argued with the order, which has been in the works since last year, that the programs have grown too large while failing to move needy people out of government help.

“Since its inception, the welfare system has grown into a large bureaucracy that might be susceptible to measuring success by how many people are enrolled in a program rather than by how many have moved from poverty into financial independence,” it states.

The order is directed at “any program that provides means-tested assistance or other assistance that provides benefits to people, households or families that have low incomes.”

Democrats have blasted the effort, arguing the order blends the issues of welfare and broader public assistance programs in a deliberate way they say is intended to lower support for popular initiatives.

“Welfare” has historically been used to describe cash assistance programs like Temporary Assistance for Needy Families. Democrats and liberal activists say the Trump administration is seeking to expand the definition of welfare to mean food stamps, Medicaid and other programs as a way to demonize them.

“This executive order perpetuates false and racist stereotypes about certain groups supposedly taking advantage of government assistance,” House Democratic Whip Steny Hoyer (Md.) and Rep. Barbara Lee (D-Calif.) said in a joint statement reacting to the order.

President Trump “is trying to erect a smokescreen in the shape of Reagan’s ‘welfare queen’ so people don’t see he’s coming after the entire middle and working class,” said Rebecca Vallas, managing director of the Center for American Progress’s Poverty to Prosperity Program.

Welfare reform has long been a goal of GOP lawmakers, and there’s broad support in the Republican conference for changing the federal safety net to impose stricter work requirements and block grant state funding for programs like Medicaid and food stamps.

While noting that he hadn’t seen the specific text of the executive order, Rep. Tom Cole (R-Okla.) said he supports the concept.

With Republicans in total control of the government, conservatives have been hoping for a major legislative push to overhaul federal assistance programs.

Speaker Paul Ryan (R-Wis.) late last year said he wanted Republicans to work on entitlement reform, with a focus on promoting work and career-based education.

“We want to smooth the path from welfare to work, pull people out of poverty, pull people out of welfare,” Ryan said in December.

Robert Rector, a senior research fellow at the Heritage Institute, said the executive order is meant to signal support to congressional Republicans.

“[Administration officials] have been talking to Congress, and the executive order is designed to set the table for them,” Rector said. “Do what they can in the executive branch, and give support to similar efforts on the Hill.”

But a short legislative calendar and a slim Republican majority in the Senate mean the administration may be largely on its own.

Agencies are limited in what changes they can make to their programs, so comprehensive welfare reform may be off the table without major legislation.

Republicans have already acknowledged they won’t be able to cut spending on entitlement programs like Medicare, Medicaid and Social Security.

“I think it’s very tough to get this thing through the Senate when it requires 60 votes. I certainly don’t have any problem with the president taking initiative,” Cole said.

The executive order doesn’t set any new policy, but Center for American Progress’s Vallas said the order is important as a messaging document, and it shows that Trump is willing to act without Congress.

“This is more of President Trump not being content to wait for Congress to dismantle these programs. This is him wanting to take matters into his own hands,” Vallas said.

The order follows policy shifts already underway at various agencies.

Health and Human Services officials have encouraged states to pursue work requirements for Medicaid beneficiaries. Arkansas, Indiana and Kentucky have already been granted such waivers, and several other states have waivers pending with the administration.

Earlier this year, the Agriculture Department sought input on “innovative ideas to promote work and self-sufficiency among able-bodied adults” participating in the food stamp program.

In Congress, House Republicans unveiled a provision in the 2018 farm bill to expand mandatory work requirements in the food stamp program. The broader legislation will be marked up later this month, but it faces a long uphill battle.

The administration’s effort could also face legal challenges. Medicaid advocates in Kentucky have already sued over the work requirements, and additional safety net changes could provoke even more lawsuits.

In closed-door meetings at the United Nations in March, Trump administration officials pushed socially conservative views on women’s rights issues — including abstinence-based policies over information about contraception — that were further to the right than those expressed by most other countries present, including Russia and the representative for the Arab states, UN officials who attended the meetings told BuzzFeed News.

The Trump officials’ approach at the UN meeting makes it clear that the administration intends to extend its views on abortion, contraception, and sexual education beyond US borders to an extent that is unusual even for Republican administrations.

The comments came during the annual UN Commission on the Status of Women, a two-week session described by a spokesperson for the US Mission to the United Nations as the UN’s “most important meeting on women’s empowerment.” The main event is a closed-door negotiation on language to include in an annual UN document that sets global standards and outlines potential policies pertaining to gender equality efforts in all member countries.

Early in this series of meetings, Bethany Kozma — a senior adviser for gender equality and women’s empowerment at the US Agency for International Development (USAID) and anti-transgender activist — emphasized that the US was a “pro-life nation,” sparking a strong reaction from delegates in the room, two officials in the room confirmed to BuzzFeed News.

“When she said that there was sort of a record scratch and silence,” one UN official who participated in the negotiations but asked not to be named so as to maintain a working relationship with the other member states present told BuzzFeed News. “Everyone was like, ‘are you kidding me?’”

Shannon Kowalski, the director of the International Women’s Health Coalition, said that the Trump administration’s stances on women’s health presented in the meeting were “further to the right” than they were at last year’s commission, or even under George W. Bush’s administration. While the Bush administration implemented anti-abortion policies abroad, the scope was limited to family planning programs. Trump’s policies already expand beyond those limits.

“They’re far more extreme than the US was under the Bush administration,” Kowalski told BuzzFeed News shortly after the session wrapped up. “We saw placement of ideologues within key roles who took similar positions back then, but they limited what they applied their views to.”

Throughout the two-week session, Trump administration officials discussed shifting international policy on women toward abstinence-oriented education and teaching women sexual “refusal skills.” Those views — as well as the US’s push for more conservative policies on immigration, trade and environmental regulation — ended up uniting most of the 45 CSW member states against the US on family planning issues, six sources who attended or were familiar with meetings told BuzzFeed News.

While negotiations at the UN are often political, two officials familiar with the negotiations said that they had never seen nearly all of the other membership states — many of whom have wildly different stances and priorities on family planning issues — come together against the US. The members include several countries where abortion is illegal and punishable by fines or jail time.

The Trump administration has not been shy about its stance on abortion. On his third day in office, President Donald Trump instated an expanded version of the Mexico City Policy, a rule that prevents the US from funding organizations that provide or discuss abortions with the populations they serve. While most Republican presidents have used that policy, Trump’s version applies to all US health funding abroad — not just family planning funds that prior Republican administrations regulated. This includes organizations devoted to curbing HIV/AIDS, which the Bush administration left alone, Kowalski said.

The Trump administration’s abrupt cancellation of a federal program to prevent teen pregnancy last year was directed by political appointees over the objections of career experts in the Department of Health and Human Services, which administers the program, according to internal notes and emails obtained by NBC News.

The trove shows three appointees with strict pro-abstinence beliefs — including Valerie Huber, the then-chief of staff for the department’s Office of the Assistant Secretary for Health — guided the process to end a program many medical professionals credit with helping to bring the nation’s teen pregnancy rate to an all-time low.

Prior to serving at HHS, Huber was the president of Ascend, an association that promotes abstinence until marriage as the best way to prevent teen pregnancy.

The $213 million Teen Pregnancy Prevention Program was aimed at helping teenagers understand how to avoid unwanted pregnancies. It had bipartisan support in Congress and trained more than 7,000 health professionals and supported 3,000 community-based organizations since its inception in 2010.

In the notes provided to NBC News, Evelyn Kappeler, who for eight years has led the Office of Adolescent Health, which administers the program, repeatedly expressed concerns about terminating the program, but appeared out of the decision-making loop and at one point was driven to tears.

In a July 17, 2017 note, she says she was admonished to “get in line” and told it was not her place to ask questions about the agency’s use of funds. In a July 28 note, Kappeler recalled she was “frustrated about the time this process is taking and the fact that (her staff) has not been part of the discussions.” She described being “so rattled” that “my reaction when I got on (sic) the phone was to cry.”

She and her staff “were not aware of the grant action until the last minute” — an apparent reference to the decision, it says.

Last month, Democracy Forward, a nonprofit law firm and advocacy group, sued the administration for unlawfully terminating the program after the agency took months to respond to its Freedom of Information Act request.

The group claims the newly obtained emails show that HHS violated the Administrative Procedure Act that bars arbitrary decision-making and that the political appointees thwarted the will of Congress.

“Now that we’ve seen these documents, there is no question to us why the Trump administration withheld” the emails, said Skye Perryman, the group’s lawyer. The decision to end the program “was made hastily, without a record of any reasoned decision making and under the influence of political appointees who have long opposed evidenced-based policy,” she said.

Parties suing over the action include the city of Baltimore and the Healthy Teen Network, which represents grantees across the country.

HHS has given different explanations about its decision to terminate the program, including claims that it was ineffective or that it did not conform to the president’s proposed budget. HHS did not respond to emails or answer questions about who was responsible for ending the program.

HHS spokesman Mark Vafiades directed NBC News to a fact sheet and announcement on the agency’s website. They state that 73 percent of the projects funded by the program “had no impact or had a negative impact on teen behavior, with some teens more likely to begin having sex, to engage in unprotected sex or to become pregnant.”

“The evidence stands in stark contrast to the promised results,” the statement says.

The story behind the program’s demise is one of a growing list of examples of the control Trump political appointees are exerting at federal agencies.

It is also part of a broader narrative about programs benefiting women and children becoming political targets under a president who insists he is an advocate for women’s rights and health. Under Trump, a mandate under the Affordable Care Act to cover contraceptive coverage has been rolled back, while Republicans in Congress have sought to defund Planned Parenthood and proposed budget cuts to Medicaid, which covers half of all births.

In July 2017, the Office of Adolescent Health notified 81 grantees including the University of New Mexico Health Sciences Center and Cuyahoga County, Ohio, that it would be discontinuing funding under the Obama-era program beginning this June, with some programs cut off immediately.

After the program’s 2010 inception, teen pregnancy and birth rates fell faster than ever. Health care experts say considerable research and money that has already been invested in the program will be wasted and the number of at-risk teens will increase.

The president of the American College of Obstetricians & Gynecologists and women’s health advocacy groups, such as Planned Parenthood, have expressed alarm.

Haywood L. Brown, president of ACOG, called the program “vital.” The administration’s decision, Brown said in a statement, is “highly unusual” and a “step backward for ensuring healthy moms and healthy babies.”

In an op-ed last year, Ron Haskins, previously a Republican co-chair of a bipartisan commission on evidence-based policy making established by House Speaker Paul Ryan, R-Wis., said that by ending the program, Trump has “exploded one of our most promising evidence-based programs.”

In a June 21 note by Kappeler, Steven Valentine, Huber’s deputy, is described as having “taken the lead” in reversing the program. Valentine directed Kappeler to halt the review process for the grants, the notes say.

Before coming to HHS, Valentine was a legislative assistant to Rep. Chris Smith, R-N.J., an outspoken abortion rights opponent. Valentine also worked for a short time at the Susan B. Anthony List, a political organization that supports candidates who oppose abortion rights.

Don Wright, a senior career official at HHS, stated in a July 28 email to Kappeler that he himself was only “tangentially” involved in the discussions about the program’s termination. But one set of notes documents him instructing skeptical career staff members on the appropriate behavior of civil servants. He later complained to Kappeler about “rolling of the eyes by some staff,” her notes say.

Weeks later, Wright was made acting secretary of the department.

Also according Kappeler’s notes, some staff “expressed concerns about being able to ask questions in this environment and the lack of engagement by policy staff directly with the program office.”

“The documents also show HHS disregarded the views of experienced career employees including those of the director of the Office of Adolescent Health,” she said.

Another appointee involved in terminating the teen pregnancy program was Teresa Manning, an anti-abortion activist and Trump appointee who was in charge of the department’s family planning programs and who has publicly questioned the efficacy of several popular contraception methods. She was previously a lobbyist for the National Right to Life Committee and for the Family Research Council. In January, Manning abruptly resigned.

In November, HHS announced a $10 million research initiative to ensure “any sex education programs follow the science to improve youth health and well-being,” including “sexual risk avoidance.”

Despite their popularity in some conservative regions and school districts, abstinence-only programs have been shown not to work.

A June 2005 study conducted by Case Western Reserve University found that the sexual education programs that Huber ran in Ohio promoting abstinence-only education had “critical problems.” The study suggested the program conveyed “false and misleading information” about abortion, contraceptives and sexually transmitted infections and misrepresented “religious convictions as scientific fact.”

In King County, Washington — one of the parties in the suit challenging the program’s termination — grantees created a 15-lesson sex education curriculum known as Family Life and Sexual Health (FLASH).

The FLASH program educates students on options including abstinence, the use of birth control and the importance of consent before engaging in sexual activity. It is now used in 44 states and taught in every school district in King County, which has seen a 63 percent drop in teen pregnancies since 2008.

King County was granted $5 million to conduct the first scientific evaluation of the FLASH program, and now it is unable to complete the study. The $3 million already spent is now wasted taxpayer dollars, according to King County spokesman James Apa.

The Trump Justice Department is suing Wisconsin’s Ozaukee County for alleged civil rights violations after requiring a worker at a county-run nursing home to get a flu shot — an action she said is against her religious beliefs.

Christian Post reported Wednesday that nursing assistant Barnell Williams, who worked Lasata Care Center in a town roughly 26 miles north of Milwaukee, spoke with her highest-ranking supervisor about getting a religious exemption for a policy requiring employees to get flu shots.

“Under the nursing home’s then policy,” the Christian Post noted, “an employee’s failure to receive the mandatory shot without a formal religious or medical exemption, was deemed a ‘voluntary resignation.’”

Based on her interpretation of the Bible, Williams told Campus Administrator Ralph Luedtke it was her “sincerely held Christian beliefs” that she could not put “certain foreign substances, including vaccinations, in her body because it is a ‘Holy Temple.’”

The administrator told Williams she’d need a signed letter from her pastor attesting to that belief, and when she explained that she was unaffiliated with any church, Luedtke gave her an ultimatum — get the shot or “consider this your last day.”

Williams acquiesced and got the shot, but immediately “became emotionally distraught and cried uncontrollably” in the aftermath, the DOJ’s lawsuit claims.

“Williams suffered severe emotional distress from receiving the flu shot in violation of her religious beliefs, including withdrawing from work and her personal life, suffering from sleep problems, anxiety, and fear of ‘going to Hell’ because she had disobeyed the Bible by receiving the shot,” it continued.

The suit claims that Lasata Care Center “could have reasonably accommodated Williams’ religious objection to receiving the mandatory flu shot,” and noted that it has in the interim changed its policy and no longer requires letters from clergy for religious exemptions.

A federal environmental program that distributes grants to test the effects of chemical exposure on adults and children is being shuttered amidst a major organization consolidation at the Environmental Protection Agency (EPA).

The National Center for Environmental Research (NCER) will no longer exist following plans to combine three EPA offices, the agency confirmed to The Hill Monday.

The program provides millions of dollars in grants each year.

Perhaps best known for its handling of fellowships that study the effects of chemicals on children’s health, NCER will be dissolved and science staff serving there will be reassigned elsewhere within the department, EPA said.

The merger will involve EPA’s Office of Administrative and Research Support, Office of Program Accountability and Resource Management, and the grants and contracts managed by NCER to create a new Office of Resource Management.

Other EPA functions consolidated into the new office include the handling of Freedom of Information Act (FOIA) requests, records management and budget formulation functions.

An EPA spokesperson said the extensive organizational changes are meant to create more efficiency within the agency.

“EPA’s Office of Research and Development is one of the world’s leading environmental and human health research organizations. In order to maintain the quality and focus of our research, senior leaders from the research and development office are proactively taking steps to create management efficiencies within the organization,” the spokesperson said. “These changes will help EPA’s Office of Research and Development be more responsive to agency priorities and funding realities.”

Both of the White House’s fiscal 2018 and 2019 budgets proposed zeroing out major programs under NCER, but the cuts were not taken up in the most recent congressional budget.

An EPA spokesperson said that under the planned overhaul, employees currently working at NCER will not be fired, but may have their positions altered.

“At the appropriate time, the science staff currently in NCER will be redeployed to the ORD labs/centers/offices matching their expertise to organizational needs. This reorganization could result in a change of positions or functions. Staff in the affected organizations will retain the grade and career ladder of their position of record,” the spokesperson said.

NCER is largely known for the funding it provides through its premiere program, Science To Achieve Results (STAR). Under the STAR program, grants are given to the Children’s Environmental Health and Disease Prevention Research Centers, which were established in 1988 to discover methods to reduce children’s health risks from environmental factors.

“Those programs have been so successful in advancing our scientific understanding and our ability to address the ways that environmental chemicals can impact children’s health,” said Tracey Woodruff, a former senior scientist and policy advisor at the EPA under the Clinton and Bush administrations. “The children centers were really the first and only centers to undercover the relationship with prenatal exposure to flame retardants and IQ deficiencies in children.”

A report released by the National Academy of Sciences last year that was compiled at EPA’s request, championed the STAR program for its “numerous successes.”

“STAR has had numerous successes, such as in research on human health implications of air pollution, on environmental effects on children’s health and well-being, on interactions between climate change and air quality, and on the human health implications of nanoparticles. Those are just a few examples; many more could be cited,” the report read.

Woodruff called the decision to merge NCER with the other offices, which currently do not focus on handling grants, extremely concerning.

“They make it sound like this is a way to create efficiency, but it masks what’s happening to this actually programmatic, scientific function of NCER and the STAR program. That makes you think, ‘Is this really just an efficiency argument masking their real intention to get rid of the research grant program, which they have said they want to do in the past?’ she said. “Answering FOIAs and administering scientific grants are not the same thing.”

EPA has recently acknowledged a slow-down in the rate of FOIA requests answered, citing a backlog in previous requests made under the Obama administration and an uptick in FOIA requests sent since President Trump took office.

The EPA official did not acknowledge how the agency rearrangement may address those issues.

While signing a bill that aims to combat the opioid crisis last month, President Trump hinted that he’d come up with the solution to the complex problem, but couldn’t talk about it.

“There is an answer. I think I actually know the answer, but I’m not sure the country is ready for it yet,” Trump said. “Does anybody know what I mean? I think so.”

No one knew what he meant. “Yeah, I wondered about that,” said Republican Senator Shelley Moore Capito, who was at the signing. “I didn’t follow up and ask.”

Many dismissed the comment as more of Trump’s regular, incoherent ramblings. However, now it seems the president may actually have a secret plan to fight the opioid epidemic, beyond hiring a 24-year-old ingenue as his deputy drug czar and an ad campaign that was supposed to launch during the Super Bowl but didn’t come together in time. Axios’s Jonathan Swan reports that he’s been telling friends for months that drug dealers should face the death penalty, citing policies in Singapore and the Philippines.

“He says that a lot,” said a source. “He says, ‘When I ask the prime minister of Singapore do they have a drug problem [the prime minister replies,] ‘No. Death penalty’.”

Trump is reportedly convinced that the key to ending America’s drug problems is making dealers fear for their lives and kids fear that even trying drugs will kill them — but he’s also acknowledged that the U.S. probably won’t pass a law mandating that all drug dealers be executed.

Kellyanne Conway, who is leading the administration’s anti-drug efforts, told Swan that Trump’s plan is more nuanced. “The president makes a distinction between those that are languishing in prison for low-level drug offenses and the kingpins hauling thousands of lethal doses of fentanyl into communities, that are responsible for many casualties in a single weekend,” she said.

In lieu of mass executions, the White House may push to toughen drug-sentencing laws. Per Axios:

Trump may back legislation requiring a five-year mandatory minimum sentence for traffickers who deal as little as two grams of fentanyl. Currently, you have to deal forty grams to trigger the mandatory five-year sentence. (The DEA estimates that as little as two milligrams is enough to kill people.)

Singapore has some of the strictest drug laws in the world. Police can perform random drug tests and those who test positive can face years-long sentences. Those caught with more than a few grams of certain drugs are presumed to be trafficking, and in higher quantities offenders are sentenced to death. In the Philippines, President Rodrigo Duterte instituted a brutal crackdown on both drug dealers and drug users in 2016. While the government claims that fewer than 4,000 suspects have been killed, Human Rights Watch puts the number at more than 12,000.

Trump has made it clear that unlike his predecessor, he has a cosy relationship with Duterte. He invited him to visit the White House, ignored questions about human-rights abuses during their first meeting in the Philippines, and congratulated him for doing an “unbelievable job on the drug problem” during a phone call. It was assumed that this was all part of Trump’s general admiration for authoritarian leaders, but perhaps he’s been taking more specific policy inspiration.

“A severe punishment that is clearly and totally rejected throughout society.”

“A severe punishment that is patently unnecessary.”

And he added: “The function of these principles, after all, is simply to provide means by which a court can determine whether a challenged punishment comports with human dignity. They are, therefore, interrelated, and, in most cases, it will be their convergence that will justify the conclusion that a punishment is “cruel and unusual.” The test, then, will ordinarily be a cumulative one: if a punishment is unusually severe, if there is a strong probability that it is inflicted arbitrarily, if it is substantially rejected by contemporary society, and if there is no reason to believe that it serves any penal purpose more effectively than some less severe punishment, then the continued infliction of that punishment violates the command of the Clause that the State may not inflict inhuman and uncivilized punishments upon those convicted of crimes.”

Continuing, he wrote that he expected that no state would pass a law obviously violating any one of these principles, so court decisions regarding the Eighth Amendment would involve a “cumulative” analysis of the implication of each of the four principles. In this way the United States Supreme Court “set the standard that a punishment would be cruel and unusual [,if] it was too severe for the crime, [if] it was arbitrary, if it offended society’s sense of justice, or if it was not more effective than a less severe penalty.”

President Donald Trump’s war on opioids is beginning to look more like a war on his drug policy office.

White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day. The main response so far has been to call for a border wall and to promise a “just say no” campaign.

Trump is expected to propose massive cuts this month to the “drug czar” office, just as he attempted in last year’s budget before backing off. He hasn’t named a permanent director for the office, and the chief of staff was sacked in December. For months, the office’s top political appointee was a 24-year-old Trump campaign staffer with no relevant qualifications. Its senior leadership consists of a skeleton crew of three political appointees, down from nine a year ago.

“It’s fair to say the ONDCP has pretty much been systematically excluded from key decisions about opioids and the strategy moving forward,” said a former Trump administration staffer, using shorthand for the Office of National Drug Control Policy, which has steered federal drug policy since the Reagan years.

The office’s acting director, Rich Baum, who had served in the office for decades before Trump tapped him as the temporary leader, has not been invited to Conway’s opioid cabinet meetings,according to his close associates. His schedule, obtained under a Freedom of Information Act request, included no mention of the meetings. Two political appointees from Baum’s office, neither of whom are drug policy experts, attend on the office’s behalf, alongside officials from across the federal government, from HHS to Defense. A White House spokesperson declined to disclose who attends the meetings, and Baum did not respond to a request for comment, although the White House later forwarded an email in which Baum stressed the office’s central role in developing national drug strategy.

The upheaval in the drug policy office illustrates the Trump administration’s inconsistency in creating a real vision on the opioids crisis. Trump declared a public health emergency at a televised White House event and talked frequently about the devastating human toll of overdoses and addiction. But critics say he hasn’t followed through with a consistent, comprehensive response.

He has endorsed anti-drug messaging and tougher law enforcement. But he ignored many of the recommendations from former New Jersey Gov. Chris Christie’s presidential commission about public health approaches to addiction, access to treatment, and education for doctors who prescribe opioids. And he hasn’t maintained a public focus. In Ohio just this week, it was first lady Melania Trump who attended an opioid event at a children’s hospital. The president toured a manufacturing plant and gave a speech on tax cuts.

Much of the White House messaging bolsters the president’s call for a border wall, depicting the opioid epidemic as an imported crisis, not one that is largely home-grown and complex, fueled by both legal but addictive painkillers and lethal street drugs like heroin and fentanyl.

“I don’t know what the agency is doing. I really don’t,” said Regina LaBelle, who was the drug office’s chief of staff in the Obama administration. “They aren’t at the level of visibility you’d think they’d be at by now.”

Conway touts her opioids effort as policy-driven, telling POLITICO recently that her circle of advisers help “formalize and centralize strategy, coordinate policy, scheduling and public awareness” across government agencies.

That’s exactly what the drug czar has traditionally done.

Conway’s role has also caused confusion on the Hill. For instance, the Senate HELP Committee’s staff has been in touch with both Conway and the White House domestic policy officials, according to chairman Lamar Alexander’s office. But lawmakers who have been leaders on opioid policy and who are accustomed to working with the drug czar office, haven’t seen outreach from Conway or her cabinet.

“I haven’t talked to Kellyanne at all and I’m from the worst state for this,” said Sen. Shelley Moore Capito, a Republican from West Virginia, which has the country’s highest overdose death rate. “I’m uncertain of her role.” The office of Sen. Rob Portman (R-Ohio), another leader on opioid policy, echoed that — although Portman’s wife, Jane, and Conway were both at the event with Melania Trump this week.

Some drug abuse experts and Hill allies find a silver lining, noting that Conway’s high rank brings White House muscle and attention.

“If I want technical advice, I’m going to work with Baum,” said Rep. Tom MacArthur (R-NJ), a co-chair of the Bipartisan Heroin Task Force. “If I want to get a message to the president, Kellyanne is somebody that I know I can talk to.”

“It’s a really good sign that one of the president’s top advisers has been assigned to such an important topic,” said Jessica Hulsey Nickel, president and CEO of the Addiction Policy Forum.

Baum’s email called the drug office the “lead Federal entity in charge of crafting, publishing and overseeing the implementation of President Trump’s National Drug Control Strategy,” which multiple agencies review. He called Conway’s opioids cabinet an “interagency coordinating apparatus for public-facing opioids-related initiatives” and said that it was not overseeing national policy. But several administration officials did say her cabinet was indeed focused on a variety of policies.

Whatever Conway’s ties to the president, her career has been in polling and politics, not public health, substance abuse, or law enforcement.

Some of her “cabinet” participants do have a broad, general health policy background. But they don’t match the experience and expertise of the drug office’s professional staff. In her circle is Lance Leggitt, the deputy director of the White House’s Domestic Policy Council who was also chief of staff to former HHS Secretary Tom Price. Another top Price aide, Nina Schaefer, recently returned to the Heritage Foundation. The conservative think tank then touted her as having managed “the development of the HHS response to the opioid abuse crisis,” but when POLITICO recently tried to contact her, she said through a spokesperson she was not an expert on the topic.

Among the people working on the public education campaign that Trump promised is Andrew Giuliani, Rudy Giuliani’s 32-year-old son, who is a White House public liaison and has no background in drug policy, multiple administration sources told POLITICO. Nor has Conway spent her career in the anti-opioid trenches.

“Kellyanne Conway is not an expert in this field,” said Andrew Kessler, the founder of Slingshot Solutions, a consulting group that’s worked on substance abuse with many federal agencies. “She may be a political operative and a good political operative,” he added. “But look. When you appoint a secretary of Labor, you want someone with a labor background. When you appoint a secretary of Defense, you want someone with a defense background. The opioid epidemic needs leadership that ‘speaks’ the language of drug policy.”

The set-up befuddles other experts who’ve worked on substance abuse for prior administrations. Fresh ideas are fine, they say. But the drug office has a purpose.

“The whole reason we created ONDCP in 1988 was to be a coordinating force with power in the government and to bring together 20 agencies, many reluctant to be involved in drug control,” said Bob Weiner, who served in that office in both the George W. Bush and Clinton White Houses. “This is exactly when the agency should get maximum support from the White House,” he added.

An ONDCP spokesperson told POLITICO the office “works closely with other federal agencies and White House offices, including Kellyanne Conway’s office, to combat the opioid crisis” but declined to say whether the office’s career experts have attended any of her “opioids cabinet” sessions. The drug office is still crafting the annual drug control strategy, outside the Conway group, administration officials said.

A senior White House official confirmed that officials considered kicking off the media campaign with a big splash during the Super Bowl, but that fell through. Beyond that, many experts on drug policy and substance abuse say messaging alone won’t solve the problem anyway. People with addiction need treatment, and many people get addicted in the first place to painkillers their doctors have prescribed. An ad campaign won’t solve that.

One big test for the drug office will come when Trump releases his budget Monday, which is expected to slash the office’s budget, turning much of its work over to HHS and the Department of Justice. Both departments are developing their own opioid approaches; in past administrations, the drug czar would have coordinated. Lawmakers are already sounding the alarms over the budget plan.

A bipartisan group of senators last week wrote a letter to White House budget director Mick Mulvaney, urging him to reconsider and maintain the office’s programs that “prevent and fight against the scourge of drug abuse.”

Pushback to a similar proposal last year led the Trump administration to reverse the decision and maintain the office’s budget. Lawmakers hope that there will be a similar outcome this time — along with a smarter utilization of the drug policy office.

“What we haven’t seen is the kind of coordination of critical programs that ONDCP has traditionally done,” said Sen. Maggie Hassan, a Democrat from New Hampshire, another state with one of the highest overdose death rates in the country.

Trump officials say it was the Obama administration that began undermining the drug policy office, demoting the director from the Cabinet, shrinking the staff and stressing the health aspects more than a law enforcement-focused “war on drugs.” They say the emergency requires a new approach.

Bob Dupont, who served as the second White House drug czar under President Gerald Ford, before the formal drug policy office was created, and still informally advises the Justice Department on drug policy, believes the White House will eventually realize it needs the expertise that ONDCP has to offer.

The West Wing doesn’t “have the staff or capability” to carry out drug policy work like ONDCP does, Dupont told POLITICO. “I don’t think swashbuckling your approach is going to last very long.”

Four years after the United States pledged to help the world fight infectious-disease epidemics such as Ebola, the Centers for Disease Control and Prevention is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out, U.S. government officials said.

The CDC programs, part of a global health security initiative, train front-line workers in outbreak detection and work to strengthen laboratory and emergency response systems in countries where disease risks are greatest. The goal is to stop future outbreaks at their source.

Most of the funding comes from a one-time, five-year emergency package that Congress approved to respond to the 2014 Ebola epidemic in West Africa. About $600 million was awarded to the CDC to help countries prevent infectious-disease threats from becoming epidemics. That money is slated to run out by September 2019. Despite statements from President Trump and senior administration officials affirming the importance of controlling outbreaks, officials and global infectious-disease experts are not anticipating that the administration will budget additional resources.

Two weeks ago, the CDC began notifying staffers and officials abroad about its plan to downsize these activities, because officials assume there will be “no new resources,” said a senior government officialspeaking on the condition of anonymity to discuss budget matters. Notice is being given now to CDC country directors “as the very first phase of a transition,” the official said. There is a need for “forward planning,” the official said, to accommodate longer advance notice for staffers and for leases and property agreements. The downsizing decision was first reported by the Wall Street Journal.

The CDC plans to narrow its focus to 10 “priority countries,” starting in October 2019, the official said. They are India, Thailand and Vietnam in Asia; Jordan in the Middle East; Kenya, Uganda, Liberia, Nigeria and Senegal in Africa; and Guatemala in Central America.

Countries where the CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda and Congo. Last year, when Congo experienced a potentially deadly Ebola outbreak in a remote, forested area, CDC-trained disease detectives and rapid responders helped contain it quickly.

In Congo’s capital of Kinshasa, an emergency operations center established last year with CDC funding is operational but still needs staffers to be trained and protocols and systems to be put in place so data can be collected accurately from across the country, said Carolyn Reynolds, a vice president at PATH, a global health technology nonprofit group that helped the Congolese set up the center.

This next phase of work may be at risk if CDC cuts back its support, she said. “It would be akin to building the firehouse without providing the trained firemen and information and tools to fight the fire,” Reynolds said in an email.

If more funding becomes available in the fiscal year that starts Oct. 1, the CDC could resume work in China and Congo, as well as Ethiopia, Indonesia and Sierra Leone, another government official said, also speaking on the condition of anonymity to discuss budget matters.

In the meantime, the CDC will continue its work with dozens of countries on other public health issues, such as HIV, tuberculosis, malaria, polio eradication, vaccine-preventable diseases, influenza and emerging infectious diseases.

Global health organizations said critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak. The risks of deadly and costly pandemic threats are higher than ever, especially in low- and middle-income countries with the weakest public health systems, experts say. A rapid response by a country can mean the difference between an isolated outbreak and a global catastrophe. In less than 36 hours, infectious disease and pathogens can travel from a remote village to major cities on any continent to become a global crisis.

On Monday, a coalition of global health organizations representing more than 200 groups and companies sent a letter to U.S. Health and Human Services Secretary Alex Azar asking the administration to reconsider the planned reductions to programs they described as essential to health and national security.

“Not only will CDC be forced to narrow its countries of operations, but the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance, and research,” wrote the coalition, which included the Global Health Security Agenda Consortium and the Global Health Council.

The coalition also warned that complacency after outbreaks have been contained leads to funding cuts, followed by ever more costly outbreaks. The Ebola outbreak cost U.S. taxpayers $5.4 billion in emergency supplemental funding, forced several U.S. cities to spend millions in containment, disrupted global business and required the deployment of the U.S. military to address the threat.

“This is the front line against terrible organisms,” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks. He now heads Resolve to Save Lives, a global initiative to prevent epidemics. Referring to dangerous pathogens, he said: “Like terrorism, you can’t fight it just within our borders. You’ve got to fight epidemic diseases where they emerge.”

Without additional help, low-income countries are not going to be able to maintain laboratory networks to detect dangerous pathogens, Frieden said. “Either we help or hope we get lucky it isn’t an epidemic that travelers will catch or spread to our country,” Frieden said.

The U.S. downsizing could also lead other countries to cut back or drop out from “the most serious multinational effort in many years to stop epidemics at their sources overseas,” said Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

The United States helped launch an initiative known as the Global Health Security Agenda in 2014 to help countries reduce their vulnerabilities to public health threats. More than 60 countries now participate in that effort. At a meeting in Uganda in the fall, administration officials led by Tim Ziemer, the White House senior director for global health security, affirmed U.S. support to extend the initiative to 2024.

“The world remains under-prepared to prevent, detect, and respond to infectious disease outbreaks, whether naturally occurring, accidental, or deliberately released,” Ziemer wrote in a blog post before the meeting. “. . . We recognize that the cost of failing to control outbreaks and losing lives is far greater than the cost of prevention.”

The CDC has about $150 million remaining from the one-time Ebola emergency package for these global health security programs, the senior government official said. That money will be used this year and in fiscal 2019, but without substantial new resources, that leaves only the agency’s core annual budget, which has remained flat at about $50 million to $60 million.

Officials at the CDC, the Department of Health and Human Services and the National Security Council pushed for more funding in the president’s fiscal 2019 budget to be released this month. A senior government official said Thursday that the president’s budget “will include details on global health security funding,” but declined to elaborate.